Use of language: quality and quantity of speech. The tone, associations and fluency of speech should be noted

Common thought disorders
a. Pressured speech: rapid speech, which is typical of patients with manic disorders
b. Poverty of speech: minimal responses, such as answering just “yes or no”
c. Blocking: sudden cessation of speech, often in the middle of a statement
d. Flight of ideas: accelerated thoguhts that jump from idea to idea, typical of mania
e. Loosening of associations: illogical shifting between unrelated topics
f. Tangentiality: thought that wanders from the original point
g. Circumstantiality: Unnecessary digression, which eventually reaches the point
h. Echolalia: echoing of words and phrases
i. Neologisms: invention of new words by the patient
j. Clanging: speech based on sound, such as rhyming and punning rather than logical connections
k. Perseveration: repetition of phrases or words in the flow of speech
l. Ideas of reference: interpreting unrelated events as having direct reference to the patient, such as believing that the television is talking specifically to them

Hallucinations: false sensory perceptions, which may be auditory, visual, tactile, gustatory or olfactory

Delusions: fixed, false beliefs, firmly held in spite of contradictory evidence
I. Persecutory delusions: false belief that others are trying to cause harm, or are spying with intent to cause harm
II. Erotomanic delusions: false belief that a person, usually of higher status, is inlove with the patient
III. Grandoise delusions: false belief of an inflated sense of self worth, power, knowledge or wealth
IV. Somatic delusions: false belief that the patient has a physical disorder or defect

Illusions: misinterpetations of reality

Derealization: feelings of unrealness involving the outer environment

Depersonalization: feelings of unrelaness, such as if one is outside of the body and observing his own activities

Suicidal and homicidal ideation: requires further elaboration with comments about intent and planning (including means to carry out plan)

F. Cognitive Evaluation

Level of consciousness

Orientation: Person, place and date

Attention and concentration: repeat five digits forwards and backwards or spell a five-letter word (“world”) forwards and backwards

Short-term memory: ability to recall three objects after 5 minutes

Fund of knowledge: ability to name past five presidents, five large cities or historical dates

Calculations: subtraction of serial 7s, simple math problems

Abstraction: proverb interpretation and similarities

G. Insight: ability of the patient to display an understanding of his current problems, and the ability to understanding the implication of these problems

H. Judgment: ability to make sound decisions regarding everyday activities. Judgment is best evaluated by assessing a patient’s history of decision making, rather than by asking hypothetical questions

III. Symptom check-list (e.g. DSM-5)

Depression: SIG E CAPS

S leep changes: increase during day or decreased sleep at night

I nterest (loss): of interest in activities that used to interest them

Do you feel like your thoughts are racing, or feel that everything around you is going too slow?

Do you feel that you are always on the go, and have lots of plans?

Do you feel like you need less sleep? How many hours do you sleep?

Do you feel like you have a lot of energy?

How often do you feel this way? Daily? How many days in a week?

Hypomania vs Mania:

If hypomania, episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

Hypomania episodes can occur in bipolar I, but are not required for the dx of bipolar I

Schizophrenia:

Do you hear things that are not there? Do you hear things that are out of the ordinary?

When was the last time this occurred?

Do you see things that are not there? Do you see things that are out of the ordinary?